Written by: Jillian Allison Michigan State University
College of Veterinary Medicine Class of 2016
Patient name: Cracker
Signalment: 14-year-old, female spayed,
Pembroke Welsh Corgi
Clinical Problems:
- Thin with history of frequent gastrointestinal issues
- History of acute-onset hindlimb ataxia in the summer of 2014
- History of CT scan showing protruding disks at L2-L3, L3-L4, L7-S1 in 9/2014
- History of right hemilaminectomy surgery at T13-L1 on 1/24/2015
- Bilateral carpal valgus conformation and borderline for carpal hyperextension on 2/5/2015
- Ongoing post-operative hindlimb paraparesis with absent conscious proprioception and hopping on 2/5/2015
- Generalized moderate-severe muscle atrophy (shoulders, thighs, and paraspinal muscles) on 2/5/2015
- Degenerative Joint Disease in carpal and elbow joints bilaterally on 2/5/2015
Rehabilitation Goals:
- Strengthen core muscles to support spine
- Improve balance, proprioception, and coordination
- To strengthen shoulder and thigh muscles
- To regain ability to use hindlimbs and walk
Modalities used in rehabilitation program:
- Therapeutic exercises:
- Supported standing, walking, and postural sitting.
- Stretching spine and supported standing/rocking over 50cm peanut.
- Walking up ramp supported by FitBONES or balance disc led by a trail of cookies with toe tickles, standing on ramp to support core strength.
- Low cavalettis (beginning with 1” and progressing to 2-3” for 10-15 minutes) to increase thigh strength and body awareness.
- Therapeutic massage: for pain relief and to help increase mobility.
- Underwater treadmill: used to increase muscle strength, support weight, help with balance, increase range of motion, and decrease impact on joints.
- Began at 0.3 mph for 6 minutes total, barely used hindlimbs, mostly floated, but did some supported standing on breaks on 2/10/2015.
- Has progressed to 0.4 mph for 7.5 minutes total with forelimbs and hindlimbs walking in cadence, hindlimbs were extending more and were in a more natural position on 3/26/2015.
- Land treadmill to help with muscle strength and assessing gait:
- Began at 0.5 mph for 2 minutes total supported by pelvic harness, did well and scuffed with right hindlimb on 3/17/2015.
- Has progressed at 0.5 mph for 2 minutes at 3% incline supported by pelvic harness and had less knuckling with both hindlimbs on 3/26/2015.
- Aromatherapy
- Therapy laser treatment: Class IV laser therapy of hindlimbs, thoracic, and lumbar spine in order to decrease inflammation, promote blood flow, and increase tissue healing.
- Acupuncture/Electro-acupuncture: used to stimulate nerve function.
- Neuromuscular Electrical Stimulation (NMES): applied to motor points of quadriceps muscle belly at 14.0 Hz for muscle reeducation, prevention of muscle atrophy, and enhanced joint movement.
- Homework exercises: Toe pinch and tickle, paws stroke, weight shifting flat on floor, assisted walking.
Assessment:
- History: Cracker presented to Pawsitive Steps Rehabilitation and Therapy on 2/5/2015 after a right-sided hemilaminectomy at T13-L1. She had originally presented to a referral center for evaluation of acute-onset rear limb weakness, which began in the summer of 2014. Upon CT scan in September of 2014, it became evident that Cracker had multiple protruding disks (L2-3, L3-4, and L7-S1). An MRI in December of 2015 showed that the disk at T13-L1 was protruding, resulting in moderate right-ventral spinal cord compression, which was likely causing the majority of her hindlimb weakness.
- Post-operatively: After surgery, Cracker had been doing well but had not regained voluntary movement in her rear limbs. Upon presentation to Pawsitive Steps, she had difficulty with her footing on all surfaces, showed no coordinated movement in her hindlimbs, and was unable to stand on her own.
- Today: Cracker has come in for rehabilitation and therapy bi-weekly since her initial evaluation. Over this period of time, Cracker has made great strides. She has progressed to voluntarily moving her hindlimbs in a coordinated manner, is able to stand for short periods of time as long as she is balanced, can take a few steps on her own before losing balance, and can use her thigh muscles to lift her feet over low cavalettis and steps.
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